Mechanical ventilation types of ventilators

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]Syed Hassan A. Kazmi BSc, MD [3]

Mechanical ventilation may be classified into non-invasive and invasive mechanical ventilation. Non-invasive mechanical ventilation can be further sub-divided into continuous positive airway pressure breathing (CPAP), bilevel positive airway pressure breathing (BiPAP) and mask ventilation. Mechanical ventilators may also be classified based on the basic underlying mechanics of the device and the clinical condition in which it is used. Ventilation may be delivered via bag valve mask, continuous flow, transport ventilators, ICU ventilators, NICU ventilators and PAP ventilators.

Mechanical ventilation may be classified into the following types:

Non-invasive mechanical ventilation may be further classified into:^{[1][2][3][4][5]}

(a) Continuous positive airway pressure (CPAP)

• Equivalent to positive end expiratory pressure (PEEP)
• Patient breathes spontaneously at own rate
• Ventilator maintains a constant positive airway pressure throughout the respiratory cycle
• No limit of oxygen delivered (i.e. can give high flow oxygen FiO2 = 1)
• Used if primary problem is hypoxemia

(b) Bilevel positive airway pressure (BiPAP)

• Equivalent to positive end expiratory pressure (PEEP) + Pressure support ventilation (PSV)
• Able to set both inspiratory (usually 8-10 cm H2O) and expiratory pressure (usually < 5 cm H2O)
• Oxygen delivery limited
• Used if primary problem is hypovantilation

(c) Mask ventilation

• Tight-fitting mask connecting patient to a standard ventilator can receive pressure support of 20-30 cm H2O, PEEP of 10 cm H2O, FiO2 of 1.0
• Used for short-term reversible process (< 24 hours)

Ventilation can be delivered via:

• Hand-controlled ventilation such as:
  • Bag valve mask
  • Continuous-flow or anaesthesia (T-piece) bag

• Types of mechanical ventilators include:
  • Transport ventilators:
    • These ventilators are small and more rugged
    • These are powered pneumatically, or via DC or AC power sources.
  • ICU ventilators:
    • These ventilators are larger and usually run on AC power.
    • This style of ventilator often provides greater control of a wide variety of ventilation parameters such as inspiratory rise time.
    • Many ICU ventilators also use graphics to provide visuals of each breath.
  • NICU ventilators:
    • These are a specialized subset of ICU ventilators which are designed to deliver the smaller, more precise volumes and pressures required to ventilate these patients.
    • These are used specially for preterm babies.
  • PAP ventilators: These ventilators are specifically designed for non-invasive ventilation at home for sleep apnea.

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